Tuesday, March 17, 2009

Disparities in Healthcare

There are challenges to delivering healthcare to rural and underserved areas according to Neal Neuberger, Executive Director for the Institute for e-Health Policy. He was speaking before a packed room at the Capitol Hill Steering Committee on Telehealth and Healthcare Informatics briefing held on March 13th. The problems concern the lack of a business case for connectivity, no aggregate buying power exists, areas are isolated with lower incomes, less private insurance available, areas have many older rural residents, plus there are cultural and language barriers.

“Increasing the use of the internet, ehealth and other information technologies among minority populations is the tool to use to reduce health disparities. These technologies have the potential to facilitate behavior change, improve healthcare, and enhance health outcomes”, said, Garth N. Graham MD, MPH, Deputy Assistant Secretary for Minority Health, Office of the Secretary, HHS.

Dr Graham emphasized we must focus on the underserved population since chronic diseases are increasing, more disabilities occur in underserved areas, more obesity exists along with heart disease, diabetes, and HIV/AIDS, and fewer doctors tend to practice in rural areas.

Dr Graham continued to say if more providers had health IT, there would be more access for the uninsured along with better chronic disease coordination and management. Health IT would help providers locate specialty care, track patients and their eligibility for Medicaid, generate reminders at the point-of-care, use e-prescribing with clinical decision support, have immediate access to the patients records, and be able to generate custom reports.

To help address the need to reduce disparities in healthcare, HHS established the “Work Group on Health IT and Underserved Populations” to look at ongoing activities, challenges, and potential opportunities to help the disparity populations.

In addition to the HHS work group, the National Health Information Technology Collaborative for the Underserved was started in 2008. The purpose of the Collaborative is to improve the health of communities and populations that have historically had the worst health outcomes and the least access to care. The objectives are to help consumers use HIT for health self-management, create a health IT workforce, and facilitate funding for health IT implementation.

Coming from Spokane Washington, Nancy Vorhees, COO, Inland Northwest Health Services (INHS), came to describe the important the services provided by INHS and how these services operate effectively in Washington, Idaho, and California. The INHS system enables 38 hospitals in the region to share a single hospital information system and patient identifier. More than 450 physicians in Washington and Alaska are able to use common EMRs, and now patient safety tools have been developed that are used in hospitals in North Carolina and Florida. To further serve the region, the INHS Telehealth network is connected to 65 hospital clinics and public health agencies.

The INHS provides for a number of community programs that entail screenings, health promotions, health education, childbirth and parenting education. In addition, INHS provides for a diabetes center and helps employees maintain their health by providing worksite wellness programs.

As Vorhees pointed out, INHS was successful because early on, the leaders at INHS developed an IT strategic plan, learned from their experiences, and INHS only used vendors that were successful in the field.

Michael Lardiere, Director of Health IT and Senior Advisor, Behavioral Health for the National Association of Community Health Centers, reported that the stimulus funds will help the centers by providing $1.5 billion for construction, renovations, equipment and to purchase health IT.

He explained that providers in Federally Qualified Health Centers (FQHC) are eligible to receive Medicaid incentives if at least 30% of their patients are defined as “needy individuals”. Patients that are covered by Medicaid include individuals in Medicaid management care, enrolled in CHIP, receiving charity care, or individuals paying for their care on a sliding fee scale basis.

He is concerned that the Medicaid incentive payments may not pay for practice management systems. Health centers need to move quickly in order to receive payments and they need to implement e-prescribing, be able to exchange information, and also be able to report clinical quality measures.

To help the centers get started with technology, Lardiere pointed out that the states will provide grants and loans but they will require matching funds such as $1 for $5 of Federal funding. The first awards must be made by January 2010.

Bill Finerfrock, Executive Director for the National Association of Rural Health Clinics reported that the incentive payments in both Medicare and Medicaid are available for physicians, hospitals, and certain other providers, but only physicians are eligible for the Medicare incentives. Physicians must choose whether to receive a Medicare incentive payment or a Medicaid incentive payment but they are not permitted to choose both.

Physicians in order to be eligible for incentive payments must be a meaningful user of a certified EHR system. Physicians are eligible for the incentive payments starting 2011 and up until 2015. By 2015, if the provider has not begun to use an EHR system then the provider will see a reduction in payment.

For more information on future briefings, contact Neal Neuberger, Executive Director for the Institute at neal@healthpolicy.org or go to the web site at www.e-healthpolicy.org.